Stop loss
Protection for self-funded health plans
Controlling healthcare costs is a concern for any business – but larger-than-expected medical claims can devastate a self-funded employer. Stop loss coverage can help protect employers who self-fund their health benefit plans.
Self-funded health benefit plans can give employers better flexibility and control over expenses, while providing important medical coverage to their employees. But with self-funding comes increased financial risk, including the possibility of medical claims that are larger or more frequent than expected. Our stop loss coverage helps employers plan confidently for the future, without the worry of catastrophic medical expenses.
A protective partnership
Employer stop loss (ESL)
Anticipating and protecting against overwhelming medical claims isn’t easy. It takes a trusted partner who will be around for the long haul. Our ESL coverage options offered to those interested in self-funding options include:
Specific coverage:
- Incurred and paid contracts
- Specific deductibles available from $25K (per state regulations) to $750K
- Eligible groups down to 25 covered lives (per state regulations)
- Coverage available in all states except Washington
Aggregating coverage:
- Incurred and paid contracts
- Monthly aggregate accommodation available
- Terminal liability option available
HMO reinsurance (HMO Re)
Our reinsurance solutions help HMOs manage growing financial risk associated with member care costs and curtail the impact of catastrophic claims. Coverage highlights include:
- Specific retentions per member ranging from $75K up to $1.5M
- Option for unlimited maximum benefit coverage per member
- Up to $10M continuation of benefit coverage
- Minimum premiums as low as $50K
- Captive reinsurance options
Provider excess insurance (PEI)
Our PEI solutions support medical providers with an extra layer of protection. Whether it’s for start-up groups or well-established providers, this option can help protect against catastrophic claims.
- Specific retentions per member ranging from $25K up to $1.5M
- Option for unlimited maximum benefit coverage per member
- Minimum premiums as low as $25K
In-house clinical team and ProAct® Care Solutions
Coverage isn’t a one-size-fits-all solution, which is why our stop loss customers enjoy the added advantage of our in-house clinical review teams and ProAct Care Solutions. Specialized to help contain costs, these benefits include:
- A voluntary risk-management program that complements each client’s individual stop loss coverage plan
- The combined support of our industry-leading underwriting capabilities, best-in-class vendors, and an elite clinical team of on-staff nurses to help improve clinical outcomes and enhance care coordination
- Access to transplant and cell & gene therapy networks, case management for catastrophic claims, and specialty pharmacy management
- Access to supplemental contract negotiations, bill review, and out-of-network negotiations
- Access to our robust in-house clinical review team offering expert guidance to producer partners and informed risk assessments
- In many cases fees for vendor services can be considered as an eligible expense under the stop loss policy for members that exceed the specific deductible
Get in touch
Our commercial and specialty insurance products and services are distributed through brokers and agents. If you are interested in our solutions for your business, please contact your agent or broker. If you are an agent or broker, please reach out to our team for more information.
Michael Heffernan
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This website is intended to be informational. Descriptions are provided only as a summary outline of the products and services available and are not intended to be comprehensive and do not constitute an offer to sell or a solicitation. The products and services described may not be available in all states or jurisdictions. See your policy, service contract, or program documentation for actual terms, conditions, and exclusions. Any inquiries regarding the subject matter set forth herein should be directed through licensed insurance professionals.
Coverage and insurance are provided and underwritten by Liberty Mutual Insurance Company or its affiliates or subsidiaries. When we offer insurance products, we will state clearly which insurer will underwrite the policy. Some policies may be placed with a surplus lines insurer. Surplus lines insurers generally do not participate in state guaranty funds and coverage may only be obtained through duly licensed surplus lines brokers.
